Dem bones, dem bones, dem dry bones: your bone health

When Sophy Kohler had her first, and as it turned out last, ju-jitsu lesson, the martial arts instructor fractured her sternum. Kohler, who is now 29 and works in publishing, felt “strangely thankful” towards him, because it led to her diagnosis of osteopenia – pre-osteoporosis – and then later osteoporosis, a condition in which the bones become less dense and more likely to fracture. Kohler had also suffered a knee injury the previous year. There was no known cause to her illness, although both her mother and her grandmother suffer from osteoporosis.

Guy Ashburner, an osteopath who practises from Constantia (osteopathy is a drug- free non-invasive manual therapy that emphasises the role of the musculoskeletal system), explains that bones play a “major role in our wellbeing”. Bones provide structure, protect organs, provide an attachment for muscles, and store calcium within the body. It’s vital to consider bone health as we age, because low bone mass can result in weak bones and potentially bone illnesses such as osteoporosis and osteopenia.

After Kohler’s diagnosis, she was told that had until she was 25 to reverse the effects of the disease. “I was given a combination of things to take: calcium and vitamin D supplements, and a drug called Protos, the only drug at the time that was able to prevent the loss of bone and to build bone. I was also told not to smoke, to drink minimal alcohol and no fizzy drinks. But most of all, my doctor stressed the importance of weight-bearing exercise, like running, to stimulate bone formation.”

Ashburner confirms the importance of exercise. Physical activity and weight-bearing exercises are important in childhood as we’re developing, because it stimulates the formation of bone and strengthens muscles. Peak bone development occurs between the ages of 12 and 18; by age 18, 90% of bone structure will already have been developed. Says Ashburner: “This is the time to lay down the foundations for good bone health which reduces the risk of developing osteoporosis as we age”.

However, it’s worth bearing in mind that “bones are in a constant state of renewal,” reports the Mayo Clinic website – “new bone is made and old bone is broken down”. It’s just that when you’re younger, your body can make new bone faster than the rate at which old bone is broken down, which results in your bone mass increasing.

Even if one knows the advice one should be following, human nature being what it is, this doesn’t always happen. This was certainly Kohler’s experience. She says about her osteoporosis: “I found it difficult to take seriously – there was no ‘reward’ for taking the medication or doing the exercise, no sense of feeling better afterwards because there was nothing to feel better from. Other than the annual BMDs (bone mineral density tests), a common way to diagnose the condition, there was no way of telling if things were working. Moreover, Protos is not a great thing to have to take; in fact, they even run a support group: you must starve yourself for an hour either side and taking it is like drinking vanilla-flavoured liquid chalk. The problem with osteoporosis is that it’s a silent disease, with no real outward manifestation.”

Unfortunately, though, it’s a disease that affects many people. The South Africa National Osteoporosis Foundation notes that men are also risk, though women are four times more likely to develop osteoporosis than men. Worldwide, reports the International Osteoporosis Foundation, 1 in 3 women over age 50 will experience osteoporotic fractures – and the disease is estimated to affect 200 million women worldwide: one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) website lists the following risk factors for increasing one’s chances of developing osteoporosis:

  • Thinness or small frame
  • Family history of the disease
  • Being postmenopausal and particularly going through early menopause
  • Abnormal absence of menstrual periods
  • Prolonged use of some medications, such as those used to treat lupus, asthma, thyroid deficiencies and seizures
  • Low calcium intake
  • Lack of physical activity
  • Smoking
  • Excessive alcohol intake

Besides maintaining bone density, one should also try to keep the connections between bones, the joints, as well as the surrounding tissue, healthy.  If not, one runs the risk of developing arthritis. NIAMS distinguishes between osteoarthritis, a degenerative and painful joint disease that frequently involves the hips, knees, neck, lower back or small joint in the hand (usually developing in joints that have been injured from repeated overuse or carrying around excessive body weight), and rheumatoid arthritis, an autoimmune inflammatory disease that often involves various joints in the fingers, thumbs, wrists, elbows, shoulders, knees, feet, and ankles.

Although osteoporosis and osteoarthritis develop differently, have different symptoms, and are diagnosed and treated differently, there is some similarity with regards to coping strategies. Physical therapy can be of benefit, states the NIAMS website, including exercises that focus on “stretching, strengthening, posture, and range of motions”. Examples might include low-impact aerobics, swimming, tai chi and low-stress yoga – but always check with a medical professional first.

Despite Kohler’s initial reluctance to take her diagnosis seriously, she has since changed her approach. “It took another low-impact fracture, some 8 years after the ju-jitsu injury, for me to go back to the rheumatologist,” she says. She now takes a new weekly tablet and makes herself walk more frequently. But we should all be doing what we can to adopt a more proactive approach to keeping those bones and joints as healthy as possible for as long as possible.

Bone Health: What should we be doing

Waheed Abdurahman, Clicks pharmacist, recommends supplements that contain high dosages of elemental calcium (500mg or more per tablet), Vitamin D, Vitamin K and Boron. There are products at Clicks that contain these, or various combinations – speak to your Clicks Pharmacist or Healthcare Assistant.

The best exercises, explains Guy Ashburner, are weight-bearing and resistance. During weight-bearing exercise, your bones and muscles work against gravity and your legs bear the weight – examples include jogging, walking, stair climbing, dancing. Resistance exercise uses muscular strength to improve muscle mass and strengthen bone – for example, weight training or bodyweight exercises such as pullups or push-ups. Ashburner recommends keeping the following factors in mind when exercising:

  • Exercises strengthen only the bones used directly. Therefore, it’s a good idea to include compound weight-bearing and resistance exercises such as squats, deadlifts, press-ups and pull ups.
  • Gradually increase the levels of resistance to continue to increase bone density.
  • Before you begin exercising with weights, perform the exercise without weights to be sure you can do it using proper mechanics and without pain.
  • Good posture decreases stress on the lower and upper back as well as the neck region, and lessens the risk of injury and bone fracture.

If osteoporosis has already been diagnosed, changes to diet, an appropriate exercise and prescribed medication from your specialist and gentle osteopathic treatment should help with the condition and improve your quality of life.

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